Radiation Oncology
Expert insights on radiation treatment planning, techniques, toxicity management, and multimodal cancer care.
Recent Discussions
How to you account for motion when contouring head and neck primaries in more mobile areas such as base of tongue and larynx?
We instruct our patients not to swallow during the CT simulation. We do not account for organ motion when contouring. The duration of intrafraction swallowing during the entire course of conventional RT has been reported to be small, at 0.43% of the total irradiation time (1). van Asselen B, Raaijma...
Would you recommend pre operative (chemo)radiotherapy for a patient with a T3 N0 low rectal cancer in a patient with active Crohn's disease?
Personally, I would not recommend neoadjuvant radiation therapy. Assuming the patient is a candidate for FOLFOX chemotherapy if appropriate after surgery and pathological staging, the benefit of radiation is probably a single digit decrease in local failure. Pelvic recurrences are terrible, and that...
Is postoperative radiotherapy indicated for a 5 cm grade 2 synovial sarcoma of the knee joint?
Our approach is to treat with adjuvant radiation for any grade 2 or 3 sarcoma; thus even in this case, I would recommend treatment.I would consider smaller margins per the VORTEX trial (abstract https://www.redjournal.org/article/S0360-3016(16)30347-9/abstract ) and if wide margins would treat to 60...
Are there any contraindications to or concerns with radiating a rectal cancer patient receiving bevacizumab?
Bevacizumab has a modest radiosensitizing effect and the combination has tried to improve response rates in rectal cancers. At radiation doses normally used to treat rectal cancers, the combination does not significantly increase toxicities and hence considered safe to use. However, radiation is oft...
Is it safe to offer head and neck radiotherapy to a patient with a diagnosis of porphyria such as erythropoietic protoporphyria or porphyria cutanea tarda?
Gunn et al., PMID 19536857.
What considerations do you take when performing functional SRS for tremor?
Performing functional SRS for tremor is a complex treatment that is ideally performed in a multi-disciplinary setting in collaboration with a functional neurosurgeon and movement disorder neurology team. That being said, it is a very rewarding treatment as it can provide incredible QOL improvement f...
How would you manage a spindle cell carcinoma of the Glottic (T1-T2N0) compartment and what fractionation would you use?
Though the cancer control rate is lower with this histology, definitive radiotherapy is still an option. I have treated patients with narrow field larynx only fields at 225 cGy/fx x 28 to 29 fractions (total dose 6300 to 6525 cGy). I ask my medical oncology colleagues to give weekly cisplatin 30mg/m...
What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?
By the Ann Arbor staging system, this is stage IV disease because more than one extranodal site is involved at initial presentation. However, NCCN and other guidelines acknowledge that MALT lymphoma involving both paired organs (e.g., bilateral orbital/conjunctiva) is often best treated with RT alon...
Do you offer radiation to HCC with a single positive celiac node?
I think it's worth a discussion with the patient and evaluation in MDT and medical oncology. If the patient has good liver function (CPA, maybe B7 depending on primary size) - it is reasonable to consolidate. Node positive disease makes transplant unlikely. So in this case, I have done 15 fractions ...
At what point during first-line treatment with mono-immunotherapy for oligometastatic NSCLC is the ideal time to consider consolidative radiation/SBRT to the primary and oligometastatic sites?
What I do in general first and foremost is judge whether or not it’s appropriate to offer consolidation: reasonable indications thus far have been: oligometastatic disease status at presentation, oligoprogressive disease after therapy, limited # of sites to irradiate, safe to deliver SBRT in the ana...